Clinical–Alimentary TractEffect of Abuse History on Pain Reports and Brain Responses to Aversive Visceral Stimulation: An fMRI Study
Section snippets
Materials and Methods
We studied 20 right-handed female subjects aged 18–65 (mean age, 27.6 ± 10.0 years) years. All subjects were recruited by advertising at UNC campus and UNC hospital general and GI clinics. Ten subjects had a diagnosis of IBS, and 10 subjects were without IBS. Non-IBS subjects served as controls and were completely asymptomatic with regard to any GI symptoms. Half of the subjects in each group reported a history of sexual and/or physical abuse (sexual abuse and physical abuse, n = 8; sexual
Results
The average age of our female study sample was 27.6 ± 10.0 years, average education was 13.8 + 2.0 years, and 65% were of white ethnicity. Abused subjects were less educated than the nonabused subjects (12.8 vs 14.7 school years, respectively) (P = .03), and those with IBS and abuse had less education than all other subjects (12.0 vs 14.3 school years, respectively) (P = .02). Subjects’ age was not different between the study subgroups.
Discussion
A history of abuse and other psychosocial factors is common in patients with IBS and can exacerbate GI symptoms, influence illness experience, and affect treatment outcome.2, 3, 4, 5, 6, 7, 8, 9, 36, 37 The association of a history of abuse with the diagnosis of IBS and its poorer outcome has suggested to some that abuse history may be associated with central mechanisms of pain amplification, resulting in greater pain reports and greater clinical behavioral responses to painful visceral stimuli.
References (51)
- et al.
Health status by gastrointestinal diagnosis and abuse history
Gastroenterology
(1996) - et al.
What determines severity among patients with painful functional bowel disorders?
Am J Gastroenterol
(2000) Brain responses to visceral and somatic stimuli in irritable bowel syndrome: a central nervous system disorder?
Gastroenterol Clin North Am
(2005)- et al.
Neuroimaging of the brain-gut axis: from basic understanding to treatment of functional GI disorders
Gastroenterology
(2006) - et al.
Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe IBS
Gastroenterology
(2003) - et al.
Functional imaging of brain responses to pain (a review and meta-analysis)
Neurophysiologie Clinique
(2000) - et al.
Human brain mechanisms of pain perception and regulation in health and disease
Eur J Pain
(2005) A systematic review of neuroimaging data during visceral stimulation
Am J Gastroenterol
(2003)- et al.
Distraction modulates connectivity of the cingulo-frontal cortex and the midbrain during pain: an fMRI analysis
Pain
(2004) - et al.
The trouble with cognitive subtraction
Neuroimage
(1996)
AGA technical review on irritable bowel syndrome
Gastroenterology
Hunger and satiety in anorexia nervosa: fMRI during cognitive processing of food pictures
Brain Res
The effects of pharmacological doses of 2-deoxyglucose on cerebral blood flow in healthy volunteers
Brain Res
Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention
Gastroenterology
Longitudinal change in perceptual and brain activation response to visceral stimuli in irritable bowel syndrome patients
Gastroenterology
Parietal lobe contributions to episodic memory retrieval
Trends Cogn Sci
Functional connectivity of the prefrontal cortex and the amygdala in posttraumatic stress disorder
Biol Psychiatry
Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study
Biol Psychiatry
Sex-based differences in gastrointestinal pain
Eur J Pain
Presidential address: gastrointestinal illness and the biopsychosocial model
Psychosom Med
Sexual and physical abuse in women with functional or organic disorders
Ann Intern Med
Self-reported abuse and gastrointestinal disease in outpatients: association with irritable bowel-type symptoms
Am J Gastroenterol
Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease
Psychol Med
Irritable bowel syndrome and sexual/physical abuse history
Eur J Gastroenterol Hepatol
Sexual and physical abuse and gastrointestinal illness: review and recommendations
Ann Intern Med
Cited by (140)
Distinct gray matter abnormalities in children/adolescents and adults with history of childhood maltreatment
2023, Neuroscience and Biobehavioral ReviewsThe effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis
2023, British Journal of AnaesthesiaPractical Approaches to Working with a Gastrointestinal Psychologist
2022, Gastroenterology Clinics of North AmericaNeuroinflammatory remodeling of the anterior cingulate cortex as a key driver of mood disorders in gastrointestinal disease and disorders
2022, Neuroscience and Biobehavioral ReviewsA Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction
2022, GastroenterologyCitation Excerpt :Behavioral features include frequent use of health care services, strong denial of the role of psychological factors influencing symptoms, a history of multiple diagnostic procedures, treatments, and surgeries, and anxiety related to endoscopic rectal or pelvic examinations. Finally, early-life adverse events have been shown to cause persistent corticotropin-releasing factor systems and dysregulation of the hypothalamus-pituitary axis, resulting in heightened stress response, which may explain the link between DGBIs and trauma more broadly.86 Post-traumatic stress has been associated with an increased likelihood of IBS.87
AGA Clinical Practice Update on Management of Chronic Gastrointestinal Pain in Disorders of Gut–Brain Interaction: Expert Review
2021, Clinical Gastroenterology and HepatologyCitation Excerpt :However, because of the establishment of central sensitization,41 pain in DGBI can become persistent, even in the absence of ongoing peripheral stimulation, and worsen with minimal nonpainful stimulation, termed allodynia. This central sensitization may be accompanied by central nervous system changes, which are visible on imaging.42 Factors that predispose to the development of central sensitization in patients with DGBI include, but are not limited to, a history of abuse, anxiety, catastrophizing, and hypervigilance.42,43
Supported by K23 DK075621 (to Y.R.), DK48351, RO1 MH46959 (to D.D.), R24 DK067674 (to W.E.W. and D.D.), R24 AT002681 (to E.A.M.), P50 DK64539 (to E.A.M.), and RO1 DK48351 (to E.A.M.).
Conflicts of interest: No conflicts of interest exist.